EAU15: Large prostates: knife or laser?

22 March 2015

The Thematic Session on Male Lower Urinary Tract Symptoms (LUTS) attracted a big audience for state-of-the-art lectures on the most current issues and treatments of LUTS.

Jean-Nicolas Cornu (FR) highlighted the latest research and advances in endoscopic surgical options to treat benign obstructions. He presented current evidence on open prostatectomy, Holmium Laser Enucleation of the prostate (HoLEP), and Greenlight vaporisation, stressing that there is still little evidence for other lasers, bipolar TURP and bipolar enucleation as viable treatment options.

Cornu acknowledged that while there is Level 1 evidence for HoLEP, the treatment is not available everywhere, and that comparative data on treatment that include a long-term follow up for Greenlight vaporisation and HoLEP are still necessary. In his assessment new techniques for surgery can also be used for the treatment of prostates with a large volume, which until very recently was only done with open prostatectomy.

“The field is moving rapidly, and open prostatectomy is quickly changing from the gold standard, to the old standard,” according to Cornu.

Cosimo De Nunzio (IT) underscored the role of patient-centred therapy in treating male LUTS. He advocated a shift from a disease-centred approach, where the tumour is central, to a new paradigm where the patient and his needs, as well as those of his family, come first. This could “improve drug adherence, and reduce issues related to doctor-shopping,” said De Nunzio, and added that he is convinced the approach would lead to better overall patient care.